CompFox Logo
AboutWorkflowFeaturesPricingCase LawInsights

Updated Daily

Case Law Database

Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ7253987
Regular
Jun 29, 2012

Anna Medel vs. Employment Development Department, State Compensation Insurance Fund

The defendant sought reconsideration of an order granting the applicant a new Qualified Medical Evaluator (PQME). The defendant argued their communication with the PQME was not an ex parte violation and that the objection was untimely. The Board dismissed the reconsideration petition, finding the order was procedural, not final. The Board denied the removal petition, agreeing that the defendant's communication violated Labor Code Section 4062.3 by failing to serve the applicant 20 days prior to the PQME evaluation. Therefore, the applicant was correctly awarded a new PQME panel.

Workers' Compensation Appeals BoardPanel Qualified Medical EvaluatorPQMESection 4062.3Ex Parte CommunicationReconsiderationRemovalCumulative Trauma InjuryCervical SpineBilateral Upper Extremities
References
Case No. ADJ11629114
Regular
Sep 16, 2022

KATHLEEN PHILLIPS vs. SHORENSTEIN HAYS-NEDERLANDER THEATRES, LLC, STATE NATIONAL INSURANCE COMPANY, INC., MEADOWBROOK INSURANCE

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and modified a prior decision concerning applicant Kathleen Phillips' industrial hip injury. While affirming the finding that the Qualified Medical Examiner's (PQME) reports lacked substantial medical evidence, the WCAB rescinded the striking of those reports and the PQME's disqualification. The WCAB reasoned that striking reports and disqualifying a PQME requires specific legal grounds not present here, and the determination of substantiality relates to the weight of evidence, not admissibility. The WCAB emphasized that the PQME's reports remain part of the record, with the judge retaining discretion to assign them appropriate weight.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and OrderQualified Medical Examiner (PQME)Substantial Medical EvidenceRemoval StandardThreshold IssueInterlocutory FindingAdmissibility of EvidencePrejudiced
References
Case No. ADJ85664607
Regular
Nov 01, 2013

YANET DUARTE ORTUNI vs. LA PERLA MEXICANA A CORPORATION, INSURANCE COMPANY OF THE WEST

This case involves a defendant's petition to remove the matter due to the Presiding Workers' Compensation Judge's alleged denial of an expedited hearing on a PQME specialty dispute. The applicant countered that the PQME appointment had been canceled. The Appeals Board dismissed the petition as moot because the cancellation of the PQME appointment resolved the underlying dispute. Therefore, the Petition for Removal was dismissed.

Petition for RemovalPresiding Workers' Compensation JudgeExpedited HearingPanel Qualified Medical EvaluatorPQME specialtymootcancelled medical appointmentWorkers' Compensation Appeals Board
References
Case No. ADJ9795000
Regular
Sep 15, 2015

JACQUITA HUNTLEY vs. A.H. 2005 MANAGEMENT, PENNSYLVANIA MANUFACTURERS ASSOCIATION INSURANCE COMPANY

The applicant sought removal of a WCJ's finding that the defendant's request for a Qualified Medical Examiner (PQME) was valid. Applicant argued her prior PQME request and the defendant's failure to attach proper documentation invalidated their request. The Board denied the removal petition, adopting the WCJ's report which noted the applicant stipulated to the invalidity of her own PQME request. Furthermore, the Board admonished applicant's attorneys for making false statements and potentially violating Labor Code section 5813.

Petition for RemovalQualified Medical Examiner (PQME)Labor Code section 4061Rule 31.1StipulationTreating PhysicianOrthopedic Surgical PanelChiropractic PQMEBad Faith ActionsFrivolous Tactics
References
Case No. ADJ8996691
Regular
Feb 12, 2015

NORMA MADRIGAL vs. OXNARD EYE ASSOCIATES, EMPLOYERS COMPENSATION INSURANCE COMPANY, STATE FARM FIRE & CASUALTY COMPANY

The Workers' Compensation Appeals Board denied the defendant's Petition for Removal, finding no substantial prejudice or irreparable harm would result from the WCJ's order to take the case off calendar for a PQME evaluation. The Board determined that a PQME evaluation was necessary to properly develop the medical record regarding the applicant's psychological injury and the defendant's good faith personnel action defense. Proceeding to trial without this medical evidence could lead to a greater delay than the PQME process itself. Therefore, the petition for removal was denied.

Workers' Compensation Appeals BoardPetition for RemovalQualified Medical Evaluator (PQME)Administrative Law Judge (WCJ)good faith personnel actionLabor Code section 3208.3(h)psychiatric injurypredominant causationsubstantial causeundue encumbrance
References
Case No. ADJ9604444
Regular
Aug 14, 2017

MANUELA BALDERAMA vs. DEPARTMENT OF SOCIAL SERVICES IHSS, YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board granted the defendant's Petition for Reconsideration to amend a prior finding. The Board removed the administrative law judge's determination that the PQME's March 20, 2015 report was not substantial medical evidence, as this issue was not properly raised by the parties. However, the Board affirmed the judge's prior order that the PQME improperly canceled the applicant's reevaluation without good cause, necessitating the issuance of a replacement PQME. All other aspects of the original decision, including the denial of sanctions, were upheld.

Workers' Compensation Appeals BoardPetition for ReconsiderationPanel Qualified Medical EvaluatorPQME cancellationgood causesubstantial medical evidencesanctionsAdministrative Law JudgeFindings of Fact and OrderReplacement Panel Order
References
Case No. ADJ9638094
Regular
Apr 04, 2016

ALEJANDRO GONZALEZ CEJA vs. TREASURY WINE ESTATES, SENTRY INSURANCE CO.

The Workers' Compensation Appeals Board granted reconsideration, rescinded findings on permanent disability, and returned the case for further proceedings. The Board found the Qualified Medical Evaluator's (PQME) apportionment of 25% permanent disability to pre-existing arthritis lacked substantial evidence. Specifically, the PQME failed to adequately explain the basis and causation for this apportionment, particularly when also stating the job duties likely aggravated and accelerated the condition. The matter was returned to clarify the PQME's apportionment determination before a new decision is issued.

ApportionmentPQMECumulative traumaVineyard workerLeft shoulderLeft elbowPermanent disabilitySubstantial evidencePre-existing conditionAcromioclavicular joint arthritis
References
Case No. ADJ10084731, ADJ10084732
Regular
Nov 27, 2017

TIMOTHY BEECHAM vs. SWIFT TRANSPORTATION SERVICES, LLC

This case involved the striking of a Qualified Medical Evaluator's (PQME) report due to concerns of racial or ethnic bias. The WCJ found the PQME's deposition testimony, where she referred to the applicant's "Negro blood" and linked it to her assessment of his muscle tone and strength, indicated bias. The Workers' Compensation Appeals Board (WCAB) affirmed this decision, agreeing that such statements suggested reliance on stereotypes and improper medical conclusions. Consequently, the PQME's report was deemed not substantial evidence and was struck, with a new medical evaluation ordered.

Workers' Compensation Appeals BoardReconsiderationPanel Qualified Medical EvaluatorRacial BiasEthnic BiasSubstantial EvidenceStriking ReportNew PanelNeurologyIndustrial Injury
References
Case No. ADJ3225136 (OAK 0345446)
Regular
Aug 28, 2012

MICHAEL GIAMMONA vs. FISHER DEVELOPMENT AND TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA

This case involves defendant Travelers Property and Casualty's repeated attempts to disqualify a Qualified Medical Examiner (PQME) due to alleged conflicts of interest and the PQME's review of a prior PQME's report. The Appeals Board dismissed the defendant's petition for reconsideration, as the underlying order was an interim procedural matter, not a final decision. The Board also denied the petition for removal, finding it was inappropriately filed for the same reasons previously addressed in a prior ruling. The Board admonished the defendant for ignoring prior guidance on the proper procedural avenues.

Petition for ReconsiderationPetition for RemovalPanel Qualified Medical ExaminerPQME conflict of interestRule 41.5 disqualificationinterim procedural orderfinal ordermedical-legal discoveryworkers' compensation benefitsOakland District Office
References
Case No. ADJ8209536, ADJ8209481
Regular
Nov 28, 2017

ALBERTINA FUNEZ vs. CHARLES RIVER LABS, ACE USA, ESIS

The applicant, Albertina Funez, sought removal of a WCJ's order setting her case for trial on all issues, arguing it prejudiced her ability to prove her claims. She contended that discovery was incomplete and a psychiatric PQME determination was a prerequisite to a full trial. The majority of the Appeals Board denied the petition, agreeing with the WCJ that trial was the most effective means to resolve the PQME dispute and that applicant had not suffered irreparable harm. Commissioner Sweeney dissented, believing a trial on all issues was premature given deficiencies in the record, particularly regarding the psychiatric PQME, and that this could be wasteful of resources.

Petition for RemovalPsychiatric PQMEOrthopedic DisabilityPermanent DisabilityTemporary DisabilityCompensable InjuryDiscoveryMedical RecordsExpert Medical OpinionJudicial Resources
References
Showing 1-10 of 172 results

Ready to streamline your practice?

Apply these legal strategies instantly. CompFox helps you find decisions, analyze reports, and draft pleadings in minutes.

CompFox Logo

The AI standard for workers' compensation professionals. Faster research, deeper analysis, better outcomes.

Product

  • Platform
  • Workflow
  • Features
  • Pricing

Solutions

  • Defense Firms
  • Applicants' Attorneys
  • Insurance carriers
  • Medical Providers

Company

  • About
  • Insights
  • Case Law

Legal

  • Privacy
  • Terms
  • Trust
  • Cookies
  • Subscription

© 2026 CompFox Inc. All rights reserved.

Systems Operational